LIBRI DI REMO ARDUINI

Alla luce delle crescenti responsabilità manageriali che gravano sugli operatori sanitari, in primis i medici, nella formazione del personale sanitario sempre più spesso è richiesto lo studio delle discipline sociali, in particolare economiche. La presente pubblicazione fornisce gli elementi di conoscenza destinati sia agli studenti di discipline economico-sociali e sanitarie sia a coloro che sono operatori del settore e avvertono carenze nella loro preparazione economica.

Il volume si interroga sulla possibilità di trovare e individuare una nuova governance per le aziende sanitarie pubbliche con lo scopo di garantire la sostenibilità economica e di snellire e facilitare i processi e i meccanismi operativi gestionali, da una parte, e dall’altra di mantenere un forte e robusto controllo da parte della Regione cui spetta, da dettato costituzionale, la legislazione – concorrente – in materia di organizzazione di questo settore.

In public health care organizations, the doctor is not only important as a provider of medical services but also as the individual that determines the demand of medical services; the doctor is both a participant in the definition of demand for services and the actual person representing the offer of them. Therefore health care organizations must guarantee the possibility for the doctor to act independently. On the other hand this autonomy is limited by the fact that doctors must act within the boundaries of structures that impose rules, hierarchies and adherence to organizational levels. This is the reason why in a hospital structure the doctor does not have the possibility to act in total autonomy. Within the hospital organization conflicts arise that must be either prevented and/or managed trough both coordination and integration of processes. The 2004 reform proposed by minister Sirchia constitutes an answer to the above conflict. It was inspired by the British experience with "clinical governance". Mr. Sirchia’s law proposal creates the so called "clinical coordinator" and provides it with a position in the clinical organization’s top management with the responsibility of definition of policies as well as coordination and controls. He will act as a medical director too. But the creation of the "clinical coordinator" position rather than solve the integration problems, would have generated permanent conflicts at top management level. Luckily the law proposal did not become an act of Parliament; but the problem of finding real solutions to the conflicts arising from the diversity of medical and economic cultures remains.